Generality
Measles is a highly contagious infectious disease caused by a virus belonging to the genus Morbillivirus . The course of the infection is characterized by different symptoms: initially it recalls a cold, then, within a few days, it gives rise to very characteristic red-brown spots.
Currently, there is no specific therapy. The only things you can do are: wait for the spontaneous resolution of the infection and relieve, with some effective remedies, the most annoying symptoms.
In countries where vaccination is widespread, measles death is, today, a rather rare case, which, to happen, requires certain conditions.
What is measles?
Measles is an infectious disease, of viral origin, highly contagious and characterized by the appearance of small red-brownish skin spots.
Measles affects only the human being and is widespread throughout the world, although it has become somewhat less common since vaccination has existed.
WHO HITS?
All unvaccinated individuals, who have never had the disease alive in them, are potentially at risk of getting measles.
Figure: the measles virus
A second infection is indeed possible, but very unlikely; this is because the immune response, which the human body realizes when it takes measles, is effective and lasting.
Epidemiology
Measles is considered an infectious infantile disease, such as rubella, chickenpox, pertussis and mumps, as it mainly affects children between 12 months and 4 years (NB: we are talking, of course, of subjects at risk, ie unvaccinated and that never had measles in their lives).
Today, its spread (especially in industrialized countries, including Italy) has dropped considerably thanks to the implementation of an effective vaccine.
Nevertheless, fatal cases still occur: some authoritative sources, in fact, report that death due to complications of measles involves between 30 and 100 individuals per 100, 000 sick people.
Measles in Italy
For many decades now, in our country every case of measles must be notified to the health authorities in the area.
Furthermore, following the epidemic that broke out between 2002 and 2003, a special measles surveillance system was established: according to this protocol, the physician must report any suspected cases to the nearest local health authority, which received the reporting, has the task of carrying out all the most appropriate laboratory investigations and communicating the results to the Ministry of Health and to the National Center for epidemiology, surveillance and health promotion ( Cnesps ).
Causes
Table . The cases of measles in Italy, from 2001 to 2009. | |||
Year | M | F | Total |
2001 | 464 | 358 | 826 |
2002 | 9362 | 8644 | 18, 020 |
2003 | 6363 | 5, 608 | 11, 978 |
2004 | 380 | 305 | 686 |
2005 | 115 | 100 | 215 |
2006 | 302 | 269 | 571 |
2007 | 340 | 253 | 595 |
2008 | 2875 | 2426 | 5312 |
2009 | 423 | 336 | 759 |
Measles is caused by a virus belonging to the genus morbillivirus, which in turn is part of the order mononegavirales and of the paramyxoviridae family.
The morbilliviruses have a capsid (an outer shell that protects the virus from the dangers of the external environment) and possess, for genetic material, only one strand of RNA .
SPECIES OF MORBILLIVIRUS
There are various species of morbilliviruses ; these species, which can infect not only humans but also other mammals, are:
- Canine distemper virus
- The cetacean morbillivirus
- The measles virus
- The plague virus of small ruminants
- Seal distemper virus
- The rinderpest virus
HOW CAN YOU TRANSMIT THE VIRUS DEL MORBILLO?
By coughing and sneezing, people expel millions of small volatile droplets . If the subject is affected by the virus, these droplets contain the virus; therefore, their inhalation, by those nearby, involves the transmission of the infection.
Once inhaled, in fact, measles nestles at the level of the mouth and the lungs, where it multiplies until it reaches a numerical quota such that it can spread throughout the rest of the body.
The transmission of the virus through volatile droplets represents a direct mode of infection.
The indirect transmission of measles
Volatile droplets containing the virus can settle on objects and make them a means of infection. In fact, those who touch such objects can become infected, especially if after manipulating them he puts his hands in his mouth or brings them close to his nose.
The transmission of measles according to the aforementioned methods is an indirect transmission.
PLEASE NOTE: the viral particles survive on the surface of the objects only a few hours, after which they die.
Symptoms
To learn more: Symptoms of Measles
Method of transmission of measles :
direct:
- Volatile droplets expelled with sneezing, coughing, breathing (rare)
indirect:
- Touch the objects contaminated by volatile droplets
Measles begins with a series of symptoms reminiscent of a cold or flu ; subsequently, it is characterized by a later sign: the skin rash which is the distinctive manifestation of the disease.
INITIAL SYMPTOMS
The appearance of the first symptoms occurs after about ten days from the infection ( incubation period ). These symptoms consist of:
- Typical manifestations of colds, namely: runny nose, teary eye, swollen eyelids, sneezing etc.
- Red eyes and sensitivity to light
- High fever, even at 40 ° C
- Fatigue, irritability and a sense of lack of strength
- Pain and malaise
- Dry cough
- Formation of small gray-whitish spots at the level of the mouth and throat (Köplik sign)
- Loss of appetite
The duration of this symptomatology is about 7-10 days.
THE CHARACTERISTIC SIGN OF MORBILLO: THE RASH CUTANEOUS
The hallmark of measles is the skin rash (or rash ), which causes the appearance, on the whole body, of reddish spots, slightly in relief and of variable size.
Spreading over the rest of the body requires one or two days, while, for complete disappearance, it is generally necessary to wait 4 to 7 days.
Measles timing | |
Event | When does it happen? |
Appearance of initial symptoms | 10 days after infection (incubation period) |
Appearance of skin rash (or rash) | 2-4 days after the onset of symptoms |
Resolving initial symptoms | 7-10 days after their appearance |
Resolution of the skin rash (or rash) | 4-7 days after its appearance |
WHEN AND HOW TO REFER TO THE DOCTOR?
If the skin rash and the symptoms that led to it may be due to measles, you should contact your doctor immediately and describe the disorders.
Warning: to contain the spread of the virus, it would be better if the first contact with the doctor took place by telephone.
Complications
Measles can lead to several complications, some of them very serious and sometimes lethal.
The individuals most at risk of complications are:
- Children less than 12 months old
- Undernourished children
- Children with a very weak immune system. For example, AIDS patients and those suffering from leukemia are being treated with chemotherapy
- Teenagers and adults
People less at risk, on the other hand, are healthy children over a year old.
COMPLICATIONS: FROM THE MOST COMMON TO THE RAREST
Complications related to measles can be distinguished by frequency, as there are some more common than others.
The complete picture of all the possible complications is the following:
- Most common complications . The most common complications of measles are: diarrhea, vomiting, middle ear infections ( otitis ), eye infections ( conjunctivitis ), laryngitis ( laryngeal inflammation), airway infections ( bronchitis, pneumonia and croup ) and finally, febrile convulsions.
- Uncommon complications . Infections against the liver ( hepatitis ), strabismus (due to the involvement of nerves and eye muscles), infections of the meninges ( meningitis ) and infections affecting the brain ( encephalitis ) fall into this category.
- Rare complications . On very rare occasions, measles can lead to serious eye diseases (such as optic neuritis ), serious heart problems, severe disorders of the nervous system and, finally, the so-called subacute sclerosing panencephalitis (the latter affects a measles patient every 25, 000).
Alarm bells, which signal the worsening of the situation
The symptoms that usually characterize the appearance of complications are: shortness of breath, chest pain when breathing, hemoptysis (blood emission when coughing), slackness, confusion and convulsions.
DANGERS FOR PREGNANT WOMEN
If measles infects an unvaccinated and non-immune pregnant woman, it may involve:
- Spontaneous abortion
- The death of the child at the time of delivery
- The premature birth of the fetus ( premature birth )
- The low weight of the child at the time of birth
Therefore, at the slightest suspicion of infection, a mother should immediately contact her doctor and undergo all the necessary controls.
Diagnosis
To diagnose measles, a thorough physical examination is usually sufficient, analyzing the whole symptomatology manifested by the patient.
If doubts persist, it is possible to resort to a saliva test, which is collected with a special absorbent pad, and a blood test .
Treatment
Currently there is still no drug therapy for the specific treatment of measles.
The only things an infected person can do are:
- Wait for the spontaneous resolution of the infection e
- Relieve symptoms with some special remedies / treatments
SPONTANEOUS RESOLUTION
Spontaneous resolution of measles takes 7 to 10 days. In fact, the time needed by the immune system of a healthy individual is to counteract and eliminate all traces of the virus from the body.
What happens, after healing, within the organism?
The immune system is the defensive system against threats from the external environment (primarily, viral or bacterial infectious agents).
When it fights infectious agents such as viruses, it also prepares special defense cells, capable of recognizing the same threat in advance and preventing a second infection.
This prodigious mechanism is called immune memory and the cells that put it into practice (which are particular antibodies) are called memory cells .
Antiviral vaccines are made on the concept of immune memory.
SYMPTOMS CARE
To learn more: Medicines for the treatment of Measles
When the infection is particularly annoying, it is possible to alleviate the symptoms with some simple remedies, sometimes very effective.
To relieve fever, generalized pain and a sense of discomfort : in these situations, it is good practice to take some anti-inflammatory and analgesic drugs, such as paracetamol and ibuprofen (which is a NSAID, which is a non-steroidal anti-inflammatory drug ).
Warning: remember that aspirin, in individuals under the age of 16, can have very serious side effects, such as Reye's syndrome; therefore, it should not be administered until a certain age.
Figure: steam inhalation to mitigate cold symptoms. They need a basin filled with hot water and a towel to put on the head.
To avoid dehydration : high fever causes intense sweating, therefore, to avoid excessive dehydration of the tissues, it is necessary to drink a lot of water.
To mitigate inflammation in the eye (swollen eyelids, red eyes, watery eyes, etc.) and discomfort from light sensitivity : it is essential to keep the eyes clean with special cotton buds and avoid touching them with unclean hands. Moreover, it is good that the room in which the patient resides is poorly lit, so as not to over-strain the eyes.
To treat cold symptoms (runny nose, cough etc.) : the main remedies for these disorders are steam inhalations and hot drinks made from lemon or honey.
To limit the spread of infection : to avoid transmission of the disease (especially among people potentially at risk complications, such as newborns and pregnant women) it is good practice to stay isolated at home (so do not go to work or school), until the end of the rash. In fact, during the time in which the rash disappears, the infectious charge (or the ability to infect other people) also runs out.
Prevention
Measles is preventable with the MMR vaccine (where M stands for measles, P for mumps and R for rubella).
This vaccination should be performed during childhood, with two injections: one at about 12-13 months and another at 5-6 years (usually just before starting elementary school).
Special case: for non-vaccinated adult individuals and children under one year of age, the vaccine is not essential / expected. It becomes, however, if the risk of a contagion is concrete. Two classic situations that require an extraordinary vaccination, so to speak, are: a trip to geographical areas where the virus is highly diffused or the infection happens to a very close member of the family.
What changes since 2017
With the decree law on the prevention of vaccination for minors from zero to 16 years, approved on 07/28/2017 the vaccination against measles has become mandatory .
This specific vaccination can be performed with a single injection together with 3 other vaccination covers (the so-called quadrivalent MPRV vaccination, which includes vaccines: anti-measles, anti-rubella, anti-mumps, anti-varicella).
- The obligation of vaccination against measles is in force, in the context of the 10 mandatory vaccinations, for those born from 2017. Even those born after 2001 are subject to the obligation of vaccination against measles .
- Immunized subjects due to the natural disease are exempted from the vaccination requirement, therefore children who have already contracted measles will not have to be vaccinated against this disease
Please note that compulsory vaccinations are a requirement for admission to nursery schools and kindergartens (for children from 0 to 6 years) and that the violation of the vaccination requirement implies the application of significant financial penalties .
For more information on mandatory vaccines in children, see this article.
VACCINATION AND INFANTS UNDER 6 MONTHS
Children under 6 months of age born of a vaccinated or immune mother have immunity of maternal origin that temporarily protects them; therefore, they do not need to be vaccinated.
Conversely, children of the same age who do not have a vaccinated or immune mother, are unprotected and more likely to contract the disease. For these subjects, therefore, the hypothesis of performing an injection of protective immunoglobulins could be considered.
NB: immunoglobulins, also called antibodies, are proteins of the immune system that deal with fighting infectious agents, and forming so-called immunological memory. An extra injection of them, as in the aforementioned case, does not amount to a vaccine, but it can still represent a valid anti-infective solution.
VACCINATION AND PREGNANCY
Unvaccinated and non-immune women who want to have a child can contact their doctor and ask for clarifications. Vaccination against measles in these situations is not essential and can be replaced by an injection of immunoglobulins.